This application is for a Mid-Career Investigator Award in Patient-Oriented Research (K24). Through this award, my goals are to increase: 1) my productivity in patient-oriented research; 2) increase mentorship of beginning investigators; and 3) awareness of the interface between substance abuse and infectious diseases. My research to date has broadly involved epidemiological, health services outcomes and intervention studies involving drug users with or at risk for HIV. My focus has involved interventions targeting out-of-treatment drug users - primarily in community and correctional settings. These settings are complementary as HIV+ drug users (HIDUs) filter between these two domains, both of which offer unique opportunities for intervention. Specifically, I am now developing NIDA-funded programs of directly observed therapy (DOT) for HIV treatment in correctional, community and the transition between these settings. This research uses a randomized controlled trial design with biological (HIV-1 RNA, CD4 count, HIV-1 genotypic resistance), behavioral (adherence, HIV quality of life, self-efficacy) and health services (entry into and retention in drug treatment, use health care services) outcomes. Similar to drug treatment and correctional systems, DOT provides a structure for adherence to antiretroviral therapy (ART). Without strict adherence, HIDUs will experience poor health outcomes, increased infectivity to others by inadequately suppressed HIV-1 RNA levels and develop resistance to HIV medications that can then be transmitted to others. Therefore, development and evaluation of such programs may impact on the organization of and health care delivery for HIDUs. The K24 mechanism is ideally suited for my career development. In addition to being committed to increase my level of mentorship, I have a long-standing history of external funding to provide a research infrastructure for beginning investigators. I work within an exceptional institution with expertise in the areas of substance abuse, infectious diseases, and HIVIAIDS, from which qualified candidates can be recruited. I have a commitment from the institution to reduce my clinical and administrative duties so that I can focus on scholarly research and mentorship. I have effectively mentored a small number of beginning investigators who have moved on to independent careers. Lastly, I have long-term goals of developing a novel institutional training program in the interface between substance abuse and infectious diseases. Therefore, if allowed the opportunity to decrease my current clinical and administrative responsibilities, I am likely to be able to achieve my short- and long-term career development goals.